Thursday, October 14, 2010

Sit down and shut up!

Yesterday, a very important concept blossomed from the discussion that the yoga class is not only a place to teach but also a place to provide a safe environment. Yoga traditionally has been used to prepare the practitioner to enter into stillness. Stillness of the mind doesn't mean "not moving". Yoga is meant to harmonize the connection between mind body and spirit. When I make recommendations to patients for considering Yoga, the answer is usually "I'm not flexible", then I mention it will help get you to a state where you can meditate; "I can't sit still". I even remember discussing yoga with a collegue in the ER, she said the poses used to get her so sweaty, she would slip off the mat and get frustrated! (I love her but... perhaps we need private lessons first?) Even in current times, we are not given tools to relax. Most of our coping skills as adults come from learned experience from childhood.

The earliest childhood experiences- I remember occasionally getting placed "in the corner" which is probably a way to reflect and meditate. Or perhaps going to church during school with classmates and being told to be quiet, fold your hands and pray. I recall praying before state finals for track and field and having one way conversations with an image of the Virgin Mary or Jesus. Or perhaps it was the few seconds before taking off from a long jump I would repeat the visualization of me taking flight, and taking flight again and again. During this time, nothing else would enter the mind. Kind of like stillness. Or perhaps playing wide receiver in 8th grade (for a whole 2 weeks) there would be the excitement of the huddle, the confrontation at the line with the opposition, then the silence before the quarterback gave the "hike!" During that time, between tripod stance and "hike", time stood still. Kinda what Deepak talks about as getting into the gap, the gap between thoughts. This is where you find consciousness. No thoughts interrupt, the mind is not diverted with the 2000 thoughts per hour an average human goes through. This is when the cells of the body find peace, no influx of fight or flight hormone, no spring board from one thought, sound, sensation to another. In writing this blog, I see how athletes can get to a state of stillness, especially martial arts (before board breaking!) Short of the sports involvement though, there are very little efforts being made to attune our children (thus our future adults) on how to settle an anxious and fluttering mind.

Wait.....a thought just emerged into my mind, in a nightclub as two bone heads get to chest thumping, before the first fist flies, all the friends will pull the roosters apart and say "calm down, relax". Then one or both will start taking deep breaths like getting ready to hoist a barbell, then back to drinking.

In summary, the usual thing being taught to boys was being placed into a corner (solitary confinement), going to your room (more confinement), or being told to "hit him back" or just "shut up, be quiet!" (think fraternity) So how are societies adults supposed to react to stressors? Probably the same way as in childhood and adolescence which is why we have heart disease, high blood pressure, insomnia and sleep/sex disorders. The American Medical Association says that stress is a factor in 75% of all illnesses. I believe it is a higher percentage. With what I have learned from Mind Body Medicine/Ayurveda-the science of life, it is the spirit that is the one existing that happens to have a human experience in the form of a cell/organ/body/being not the human that has to learn to drop into stillness and find it's "spirit". This is probably why when a neophyte drops into a class or is "dragged" to practice with a friend who avidly swears by her yoga instructor, they usually get bitten and come back for more. I would say it is due to the suggested setting of intention in the beginning, the proper use of svasana poses interjected strategically during the flow of the class and the meditative breath control during and after practice especially at final relaxation pose. Whether beginner or experienced, this 60-75 minutes will work to make a change in the way the mind performs, the way the muscles feel and the way the breath(spirit) flows. How can one avoid the temporary bliss? I would like to think the feeling is from the gentle and caring voice, the compassionate heart of the instructor but I see this happening in Bikram studios and Iyengar studios (for the non-yogis, these two forms of practice are powerful but also very physical and exact so less time is spent on the relaxation and breath work) where the newbie just rants about how good it was and gets right back for enrollment. So in effect, the poses, the sequencing and flow can be powerful tools in themselves for settling the mind.

I believe in the power of yoga to heal. It is not just asana, truely the Eight Limbs of Patangali rejoice in the science of yoga as a means for finding bliss and being one with everything. The instructors of today will be wielding a very formidable tool to make people/patients feel and exist better than they can with modern medicine. The teacher that takes her position at the front of the class with little regard will potentially turn away that curious cancer patient that would have healed or the high risk lady that would have avoided another surgery on her back. We must consider our classroom has a safe/healing place and every person that walks into it as someone who desperately needs healing. Even further, all those we teach to breath and enter into stillness that begin to walk and talk yoga will attract more of the worlds "walking wounded" to also come experience true healing (and this includes the younger generation) so the epidemic of stress related disease can be vanquished. In medicine we are taught that every patient is an individual, every individual-a human being. No matter how many sick line our waiting rooms and hallways, each one has to be given 110% of a healers focused attention. I believe no matter how big our classes get, no matter how complex the personalities are, no matter how challenged the bodies appear; every student taking yoga has a story and must be given 110% of the teachers efforts to teach the lesson of the day and drop that person into stillness. When the injured, sick or dying get a respit from disease, cells feel it, the mind knows it and the spirit lives it. As teachers of yoga we have the power and responsibility to heal.

Tuesday, October 5, 2010

The Wounded Healer

I first heard this term during a conference with Caroline Myss. She was specifically referring to energy healers. I am borrowing it to speak of the "burned out physician". Before the millenium, physician burn out would be attributed to mostly ER doctors. The acuity of the patient presenting for evaluation would be one of the highest experienced by any doctor just short of the trauma surgeon, who would be called by the ER doctor upon initial evaluation and stabilization, (remember ER with George Clooney intubating a semi-dead guy before sending them "upstairs" to surgery). So this was the standard, if after finishing medical school one was to decide which specialty to apply to for resident training, when discussing ER medicine, the usual exclamation was, "high burnout". Other doc burnouts would also be the older physician just a decade shy of retirement age but getting less and less reimbursement from medical insurance companies and higher spending for malpractice, office staff, equipment.....I saw many a caring and compassionate doc, take an early retirement because of what seemed utter frustration with high bills, low payment, high malpractice and angry patients. This is not what we dreamed of in medical school thinking about a "surgical save", finding and being first to treat and solve a complicated medical illness, being the "town doctor", bringing a life into the world.

I remember when I started residency in Oak Park 1991, HMO's were becoming popular with insurance companies. There were seminars on how to fill out forms and pressing hard into the carbon copy with the number code that correlated to a diagnosis. Because of my specialty training in musculoskeletal medicine, I would have an exact diagnosis on a patients symptoms and signs but if I couldn't find it in the ICD-9 code book, I would have to label the patient's visit with some general medical illness and hope the insurance wouldn't question why the visit was so long for a "cold" when I was treating something like fibromyalgia (a "rare" diagnosis in the early 90's that I felt many women fit into I believe most other docs had the nerve to call it a "waste basket diagnosis") By the time I was in practice, these older docs were getting so upset with how slow reimbursement would take, the fact that they had to hire an additional person to deal with the paperwork, and the fact that it took so long to get things approved for treatment and most patients would blame the doc office for not approving it since the "doc was trying to keep more money in his pocket". The newer generation doctors were walking into fully functioning practices that incorporated extra manpower, software systems, electronic records and more partners so collectively, more docs could share expense, see more patients, bill more and make more. Very creative! but one problem, reimbursements continue to shrink, malpractice continues to climb, salaries remain the same but the patient load increases.

Now the mood I see is, no longer is it the hatred and resentment for insurance companies or government policy makers by the doctors, I see doctors so fed up and so young that they now are fed up with the patients. So many times I hear a complicated patient roll into the ER and the greeter, triage nurse, medical assistant and even unit secretary will start with the whispers "that guy is drug seeking, that lady is rude and an ass, that patient shouldn't be here!" and this is before I walk into the patients room as I am holding 3-4 other charts of the folks to see before the sick one. (I feel others would complain to project the feeling they received from the hostile patient that is sick and not feeling well onto me to insight contempt to the angry ill one). So the Wounded Healer/doctor of today is wounded at an earlier time in medical profession and can't retire for lack of savings. What happens if a wounded animal has no choice and is backed into a corner? Fight like savages! But in this scenario, pass the anger to someone else-the patient. I played this game and I didn't like it. I would get to the point of treating patients as a diagnosis requiring a pill. Here's your perscription and follow up with your doctor tomorrow, here's your lab results and since they are normal, take 2 days off from work, here's a psychiatrist's number, call in the morning. Treat the biggest problem, ignore the small one's and send them on in order to keep flow efficient and keep my "numbers high". In my heart I felt bad, especially if I had a patient who was alone, emotional, alot of questions or just needed a little more time to explain, a drawing board to illustrate or a shoulder to cry on but with the 5-10 charts in my hand/arms of patients waiting to be seen, I had to concentrate on time not healing.

The new wounded healer is no longer offended that he can't do his job, he is just callous. I don't mean callous like Donald Trump "your cancered!", I mean callous in the form of very little to no compassion. Doc's cannot be mean spirited or rude, (yet) since much of the compensation model includes "patient satisfaction questionaires". (This is the insurance companies way of forcing the unhappy doctor to treat with a smile.) If a factory worker isn't happy about going to work, the production line yields poor workmanship. If the farmer doesn't care about quality, animal abuse. Problem in the healthcare field, no lets call it the healing field; how can a person heal another human being if before he meets the sick, the doctor already hates walking in the room. In Ayurveda, the healer blesses the sick ("namaste" -the light in me honors the light in you). In Christianity, we bless or anoint the sick, praying for a "speedy recovery". In 1994, Stephan Schmidt Ph.D. wrote "Mindfulness and Healing Intentions: Concepts, Practice and Research Evaluation". Things like an Optimal Healing Environment (OHE), teaching mindfulness to healthcare providers, nonspecific healing factors like providing a safe environment for the patient to begin healing as they enter the room. I don't think people feel a surgical looking room with stainless steel, oxygen masks, a big red biohazard trash bin is relaxing. Had a patient contact me urgently about a persistent bloody nose that was continuing to bleed even after cautery and the doc's next suggestion was surgery! I immediately thought, general anesthesia, intravenous drugs, cold steel and cameras? for a bloody nose? Now I am sure the doc thought minor surgery with a little penlight and suture but if I thought about the scenario I just mentioned, my poor patient, she probably conjured up scenes from Schindler's List. (and I am sure that got her adrenaline and epinephrine and blood pressure higher so the bleeder in her nose bled more!)

The Saguil Approach: we can't be healing illness when illness is not allowing us to heal. If you have a "bad feeling" about your doctor, if you think the diagnosis isn't right or the medicines have too many side effects, seek out second opinion, seek out trained Integrative Medicine Physicians or ask around for alternative medicine healers (for example, your local yoga studio, reiki center, acupuncturist or chiropractor). There are many compassionate and caring doctors practicing medicine out there. Bless them for being steadfast in their healing style. Unfortunately there are also many others, ask your friends and relatives, do your research and follow your heart. It is more than just an organ that pumps blood, in sanskrit it is a Chakra or energy center with relational and contextual knowledge that can sense the energy and intention of other people, situations and things. Then when you find a healing place, yoga center or genuine healer, send the "wounded healer" to her, they need to heal as well!

Please check out:

1.Mindfulness and Healing Intention: Concepts, Practice, and
Research Evaluation
Volume 10, Supplement 1, 2004, pp. S-7ÐS-14